Multinodular Thyroid Gland with Cervical Lymphadenopathy Followed by Total Thyroidectomy

Purpose of procedure: To remove enlarged multinodular thyroid gland which was causing airway obstruction along with feeding difficulties.

Landmarks: Two horizontal collar incision with skin crease above 2 finger breadths above the sternal notch.


1. A horizontal incision of 2 finger breadth was made above the sternal notch and silk sutures were used for retraction of skin flaps. Subcutaneous flaps and platysma were divided and subplatysmal dissection was made above the incision up to the level of thyroid cartilage above and the sternal notch.

2. Strap muscles were separated with the help of retractor, exposing anterior surface of thyroid.

3. Thyroid gland was rotated medially to and middle thyroid vein was ligated.

4. Superior laryngeal artery was also ligated and external laryngeal nerve was spared during procedure.

5. Superior parathyroid was spared and identified at upper two third of thyroid at 1cm above crossing point of recurrent laryngeal nerve and inferior thyroid artery.

6. Similarly, inferior parathyroid was identified and spared which was located on the posterolateral surface of the lower pole of the thyroid.

7. Recurrent laryngeal nerve was preserved which was located between the common carotid artery laterally, the oesophagus medially, and the inferior thyroid artery superiorly.

8. Sternocleidomastoid was resected to explore the area adjacent to the lymph nodes involved.

9. Cervical lymph node involved was also removed, whereas the carotid artery, jugular vein, phrenic nerve, sympathetic ganglia, brachial plexus, were spared.

10. Eventually, thyroid gland was dissected and neck was sutured.

Conflict of Interest and Source of Funding: none

Acknowledgments: Author thanked the patient and surgeons later.


Hemiglossectomy with Tracheostomy

Contributors: Eswat Ahmad (Army Medical College, Rawalpindi, Pakistan)

Purpose of procedure:

This surgery includes removal of part of the tongue and adjacent tissues to treat carcinoma of tongue when other treatments have not been successful.


Incision on the dorsum side extends from lateral side of the tip till foramen cecum while incision in the floor of the mouth extends up to anterior pillar of tonsil.


1. Tracheostomy is done and then general anesthesia is administered.

2. Mouth is opened and mouth gag is inserted. Packing is placed in the oropharynx to prevent blood aspiration.

3. Two incisions are made as described.

4. Two halves of the tongue are then separated, genioglossus muscle is visible. Hypoglossal nerve and lingual artery are divided and clamped.

5. Posterior transverse incision is made and the remaining muscle fibers to the base of the tongue are divided.

6. Residual tongue is examined for any bleeding points.

Conflict of Interest and Source of Funding: none


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